American Indian (AI) families now living in urban areas experience disproportional health disparities associated with substance abuse and risky sexual behavior but few evidence-based prevention approaches exist to prevent, reduce and eliminate health disparities among this rapidly growing population. Family disruption, stresses related to poverty and rural-to-urban migration, and loss of cultural and social connections frequently operate as pathways to adverse health outcomes among AI families. By strengthening family functioning (parental involvement, family support, parental monitoring, and parent-child communication), a parenting intervention can help parents strengthen culturally relevant parenting skills that are consistent with promoting their children's health and well-being, and help them serve as direct sources of influence in reducing their children's risk of substance use and risky sexual behavior. The proposed study draws upon the project team's research, conducted at an NCMHD Center of Excellence, on the social determinants of AI families'behavioral health, their salient risk and resiliency factors, culturally appropriate strategies for resisting risk behaviors, and systematic methods for culturally adapting prevention programs.
The aims of the study are to create and test a culturally grounded parenting intervention for urban AI families through a modification of an existing prevention program, Families Preparing the Next Generation (FPNG). The adaptation will employ a Cultural Adaptation Model for adapting programs for new target populations in ways that increase cultural fit while maintaining fidelity to core components of the original program. The intervention will be adapted, piloted, evaluated, culturally validated, revised accordingly, and tested in a randomized control trial (RCT) involving 600 families (300 intervention, 300 control) in partnership with the three largest urban Indian centers in Arizona. Ecodevelopmental Theory provides the framework for identifying parental, family, peer, community and cultural influences on youths'substance use and risky sexual behavior. CBPR methods will be used to adapt the intervention, using feedback from focus groups of urban AI parents, AI professionals and prevention experts, and through close collaboration between the designers of the original intervention and staff of the urban Indian centers, thus increasing the capacity of those centers to provide future parenting interventions. In addition to testing the intervention's efficacy, we will assess whether and how the participants'connection to native culture and identity influences the interventions effects, and whether changes in overall family functioning lead to specific parenting practices directed at reducing their children's risk behaviors. These models and theory can inform the design and implementation of more effective, culturally relevant interventions. The resulting prevention intervention will address the needs of an under-served group severely affected by health disparities, strengthen families and help them to avoid familial and individual dysfunction, and advance knowledge on effective translational research strategies for adapting prevention interventions for ethnically diverse families.

Public Health Relevance

The proposed study responds to a need, identified by urban Indian coalitions in Arizona and across the nation, for innovative culturally grounded prevention program adaptation for urban American Indian (AI) families. Public health efforts to address unacceptably high levels of substance use and risky sexual behavior among urban AI youth can be advanced through the creation of an intervention that focuses on effective parenting strategies tailored to the cultural and social forces that urban AI families face. The CBPR methodology of the study not only integrally involves community partners and community members in the design and testing of the intervention, it builds institutional capacity for sustaining the development and delivery of this and similarly designed culturally grounded prevention interventions.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZMD1-PA (08))
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Alvidrez, Jennifer L
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Arizona State University-Tempe Campus
Schools of Public Health
United States
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Kulis, Stephen S; Ayers, Stephanie L; Harthun, Mary L (2017) Substance Use Prevention for Urban American Indian Youth: A Efficacy Trial of the Culturally Adapted Living in 2 Worlds Program. J Prim Prev 38:137-158
Ayers, Stephanie L; Kulis, Stephen; Tsethlikai, Monica (2017) ASSESSING PARENTING AND FAMILY FUNCTIONING MEASURES FOR URBAN AMERICAN INDIANS. J Community Psychol 45:230-249
Kulis, Stephen S; Ayers, Stephanie L; Harthun, Mary L et al. (2016) Parenting in 2 Worlds: Effects of a Culturally Adapted Intervention for Urban American Indians on Parenting Skills and Family Functioning. Prev Sci 17:721-31
Kulis, Stephen S; Robbins, Danielle E; Baker, Tahnee M et al. (2016) A latent class analysis of urban American Indian youth identities. Cultur Divers Ethnic Minor Psychol 22:215-28
Kulis, Stephen S; Jager, Justin; Ayers, Stephanie L et al. (2016) Substance Use Profiles of Urban American Indian Adolescents: A Latent Class Analysis. Subst Use Misuse 51:1159-73
Kulis, Stephen; Ayers, Stephanie L; Baker, Tahnee (2015) Parenting in 2 Worlds: pilot results from a culturally adapted parenting program for urban American Indians. J Prim Prev 36:65-70
Okamoto, Scott K; Kulis, Stephen; Marsiglia, Flavio F et al. (2014) A continuum of approaches toward developing culturally focused prevention interventions: from adaptation to grounding. J Prim Prev 35:103-12
Jumper-Reeves, Leslie; Dustman, Patricia Allen; Harthun, Mary L et al. (2014) American Indian cultures: how CBPR illuminated intertribal cultural elements fundamental to an adaptation effort. Prev Sci 15:547-56